Legacy Partners Insurance – Production Insurance Request

Production Insurance Request

Tell us about your production and we will shop coverage for you. If you don't know an answer yet, your best estimate is fine.
What do you need insured?
About you
Named insured (person or company)
Entity type
Primary address (no PO box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact person
Phone

Area CodePhone Number
Email
Website
Year business established
Description of operations
Eligibility
Will any production include adult or pornographic content?
Will any production include live gangster rap music?
Any unprotected or open heights above 15 feet?
Please explain the heights involved
Will any production activities take place outside the U.S. and Canada?
Please explain where and when
Any employees supplied by an employee leasing company (PEO)?
Do you understand the policy covers this one production only?
Do you enter into any co-production arrangements?
Please describe the co-production arrangements
Insurance history
Any insurance declined or cancelled in the past 3 years?
Please give details
Any prior insurance?
Prior insurance: type, company, expiration date and premium
Any losses in the past 3 years?
Losses: coverage line, date, description and amount
The production
Production name
Type of production
Number of episodes
Gross production cost (total budget)
Up to $1,000,000 for 60 days or less; up to $15,000,000 for a longer production or series
Production start date

MonthDayYear
Production end date

MonthDayYear
Number of shoot days
Shooting locations (cities and states)
Synopsis
Type of music
Decade
Artist's name
Your production company
Years of industry experience
Annual gross production cost (all productions)
Maximum budget per production
Maximum days per production
Number of productions in the next 12 months
Number of employees
Cities and states of primary shooting locations
Any shoots outside the U.S. and Canada?
Number of shoots outside the U.S. and Canada
Total shoot days outside the U.S. and Canada
Total production cost of those shoots
Any post-production operations?
Annual post-production receipts
Any equipment rental operations?
Annual rental receipts
Types of productions you do
Key personnel
List at least the executive producer or producer.
Executive producer
Producer
Director
Stunts and hazardous activities
Will any production include stunts, pyrotechnics, aircraft, drones, helicopters, boats, animals, race tracks, motorbikes, ATVs, snowmobiles, blanks, squibs, guns or other hazardous activities?
Production the stunt is in
Describe each stunt or hazardous scene
Stunt dates
Stunt coordinator name(s)
Are the stunt coordinators licensed?
Are permits required? Have they been obtained?
Safety precautions
Cast members involved in or near the stunt
Number of vehicles involved and maximum speed
Any collisions or explosions? Please describe
Any railroad scenes?
Railroad scene type
Railroad name and location
Scene description, dates and number of scenes
Confirmation
Will animals appear?
Type and breed of animal
Value of animal
Who houses and transports the animal
Animal scene dates and number of scenes
Describe the animal scenes
Do you want coverage for the animal's death, illness or injury?
Coverage you need
Coverage start date

MonthDayYear
Coverage end date

MonthDayYear
Annual policies run 12 months from the start date.
Coverage
Amount needed: rented equipment
Amount needed: rented props, sets and wardrobe
Amount needed: rented furs, jewelry, art or antiques
Amount needed: owned equipment, props, sets and wardrobe
Amount needed: third-party property damage
Excess or umbrella limit wanted
Additional coverage for annual policies
Hired and non-owned auto
Vehicles hired, loaned or donated
Days the vehicles will be used
Cost of hire (not mobile studios or film trucks)
Cost of hire (mobile studios and film trucks)
Will a bus or van be hired to transport people?
Workers' compensation
Payroll company (if any)
Number of shoot days
Texas: full-time cast and crew
Texas: part-time cast and crew
Texas: total payroll
Texas payroll by type: production, clerical, sales, editing and photography (full-time count, part-time count and payroll for each)
Other states: state, number of cast and crew, and payroll
Officers and owners
Cast coverage
Share of budget to cover
People to be scheduled: name, role and production dates
Sickness coverage requires a medical exam.
Number of volunteers
Certificates
Who needs a certificate (locations, rental houses, permit offices) and by when?
Documents
Budget top sheet

Browse Files

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Synopsis or script summary

Browse Files

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Schedule of upcoming productions (titles, dates, budgets, locations)

Browse Files

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Stunt schedule (if any)

Browse Files

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Cast schedule (if cast coverage)

Browse Files

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Anything else (location agreements, rental contracts)

Browse Files

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Final
Page
Lead Source
How did you hear about us?
Who referred you?
Where did you hear about us?
Anything else we should know?
Acknowledgment
Should be Empty:

Production Insurance Request

About you

Eligibility

Insurance history

The production

Your production company

Key personnel

Stunts and hazardous activities

Coverage you need

Hired and non-owned auto

Workers' compensation

Cast coverage

Certificates

Documents

Final